Adult Medical-Surgical Nursing Neurology Module: Brain Tumour. Radiotherapy.
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Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing
Neurology Module:Neurology Module:
Brain Tumour.Brain Tumour.
RadiotherapyRadiotherapy
Brain Tumour: DescriptionBrain Tumour: Description
A brain tumour is a localised space-A brain tumour is a localised space-occupying lesion increasing pressure occupying lesion increasing pressure within the cranium: (ICP)within the cranium: (ICP)It may be:It may be:A defined spherical mass A defined spherical mass Widespread infiltration of cerebral tissueWidespread infiltration of cerebral tissueBenignBenignMalignantMalignantPrimary or metastaticPrimary or metastatic
BrainTumour: AetiologyBrainTumour: Aetiology
Unknown aetiologyUnknown aetiology
Genetic pre-dispositionGenetic pre-disposition
Environmental pollution:Environmental pollution:
Radiation (Chernobyl nuclear disaster)Radiation (Chernobyl nuclear disaster)
Electric Pylons have been implicatedElectric Pylons have been implicated
Brain Tumour: Brain Tumour: Classification/ MorphologyClassification/ Morphology
Intracerebral gliomas (malignant: 45% of all Intracerebral gliomas (malignant: 45% of all brain tumours)brain tumours)
Tumours of specific structures(15%: usually Tumours of specific structures(15%: usually benign)benign)
Developmental tumours (20-30%: benign)Developmental tumours (20-30%: benign)
Metastases (10%: malignant)Metastases (10%: malignant)
Brain Tumour: Brain Tumour: Intracerebral GliomaIntracerebral Glioma
Malignant and infiltrates neural tissue Malignant and infiltrates neural tissue therefore difficult to remove:therefore difficult to remove:
Astrocytoma (grade I, II)Astrocytoma (grade I, II)
Glioblastoma multiforme (Astrocytoma Glioblastoma multiforme (Astrocytoma grade III, IV) grade III, IV)
OligodendrocytomaOligodendrocytoma
EpendymomaEpendymoma
MedulloblastomaMedulloblastoma
Brain Tumour:Brain Tumour:Tumours of Specific StructuresTumours of Specific Structures
Usually benignUsually benign
Meningioma (meninges)Meningioma (meninges)
Neuroma (nerves): accoustic neuroma, Neuroma (nerves): accoustic neuroma, auditory nerveauditory nerve
Adenoma (glands): pituitary adenoma Adenoma (glands): pituitary adenoma
Brain Tumour: Brain Tumour: Developmental TumoursDevelopmental Tumours
Benign remnants/ anomalies of embryonic Benign remnants/ anomalies of embryonic development:development:
Angiomas (blood vessels)Angiomas (blood vessels)
DermoidDermoid
EpidermoidEpidermoid
TeromaTeroma
CraniopharyngiomaCraniopharyngioma
Brain Tumour: MetastasesBrain Tumour: Metastases
Always malignantAlways malignant
Seeded from a primary malignant tumour Seeded from a primary malignant tumour in another part of the bodyin another part of the body
Treatment (radiotherapy, maybe also with Treatment (radiotherapy, maybe also with chemotherapy) is chemotherapy) is palliative,palliative, to relieve pain to relieve pain or symptoms associated with ↑ ICPor symptoms associated with ↑ ICP
Brain Tumour: Brain Tumour: Clinical ManifestationsClinical Manifestations
Space-occupyingSpace-occupying lesionlesion (↑ ICP). Leads to: (↑ ICP). Leads to:
Headache especially early morning, worse Headache especially early morning, worse with coughing or strainingwith coughing or straining
Projectile vomiting (without nausea)Projectile vomiting (without nausea)
Diploplia, visual disturbance, papilloedemaDiploplia, visual disturbance, papilloedema
Brain Tumour: Brain Tumour: Localised Clinical ManifestationsLocalised Clinical Manifestations
Sensory/ motor impairment:Sensory/ motor impairment:
Motor cortex tumour: seizures (Jacksonian Motor cortex tumour: seizures (Jacksonian epilepsy)epilepsy)
Cerebellar: ataxia, dizziness, nystagmusCerebellar: ataxia, dizziness, nystagmus
Frontal: Personality disorder, depressionFrontal: Personality disorder, depression
Brain Tumour: DiagnosisBrain Tumour: Diagnosis
Patient history and clinical picturePatient history and clinical picture
Papilloedema: (cerebral oedema) seen in Papilloedema: (cerebral oedema) seen in the fundus of the eye by ophthalmoscopethe fundus of the eye by ophthalmoscope
CT scanCT scan
MRIMRI
Electro-encephalogram (EEG) locates Electro-encephalogram (EEG) locates region affectedregion affected
Lumbar Puncture/ CSF for cytologyLumbar Puncture/ CSF for cytology
Brain Tumour: Brain Tumour: Medical ManagementMedical Management
SurgerySurgery
**RadiotherapyRadiotherapy: the corner-stone of treatment: : the corner-stone of treatment: pre/post-surgery or if inoperable. Reduces pre/post-surgery or if inoperable. Reduces tumour sizetumour size
Chemotherapy may complement Chemotherapy may complement radiotherapy, including intra-thecal doses radiotherapy, including intra-thecal doses
Brain Tumour: Surgery Brain Tumour: Surgery
Craniotomy to remove tumour if possible. Craniotomy to remove tumour if possible. While astrocytoma cannot be completely While astrocytoma cannot be completely removed, surgery will:-removed, surgery will:-↓ ↓ Intra-cranial pressure (ICP)Intra-cranial pressure (ICP)↓ ↓ tumour size for radiation/ chemotherapytumour size for radiation/ chemotherapy
Trans-sphenoidal excision: (pituitary Trans-sphenoidal excision: (pituitary adenoma)adenoma)Gamma knife: radio-surgery (precise “brain-Gamma knife: radio-surgery (precise “brain-mapping” and multiple beams) mapping” and multiple beams)
Brain Tumour: Brain Tumour: Nursing ConsiderationsNursing Considerations
Emotional/psychological support of the patient Emotional/psychological support of the patient and familyand family
Ensure awareness of aspects of safetyEnsure awareness of aspects of safety
Orientation to time, place, personOrientation to time, place, person
ICU: head elevated post-surgery ICU: head elevated post-surgery
Neurological assessment (Glasgow Coma Neurological assessment (Glasgow Coma Scale): motor function, sensation, speechScale): motor function, sensation, speech
Watch for signs of ↑ ICP; also disordered fluid Watch for signs of ↑ ICP; also disordered fluid balance (if posterior pituitary affected)balance (if posterior pituitary affected)
MedicationsMedications
Dexamethasone (reduces cerebral Dexamethasone (reduces cerebral oedema)oedema)
Epanutin (anti-convulsive)Epanutin (anti-convulsive)
Post-craniotomy, additional drugs are:Post-craniotomy, additional drugs are:
Analgesia Analgesia
AntibioticsAntibiotics
Mannitol as a diuretic to reduce oedemaMannitol as a diuretic to reduce oedema
Notes on RadiotherapyNotes on Radiotherapy
Usually daily session for several weeksUsually daily session for several weeks
Advise to keep the marked area dryAdvise to keep the marked area dry
Advise about effect on bone marrow Advise about effect on bone marrow function (regular blood count) function (regular blood count)
Patient will experience fatigue/ must restPatient will experience fatigue/ must rest
Should see physician if extreme fatigue, Should see physician if extreme fatigue, any infection, bruisingany infection, bruising
Reasonable isolation at homeReasonable isolation at home
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